Muscle Strain and Its Treatment
Muscle injuries are very common in sports, and it can be said that almost no one avoids them. Unfortunately, they often lead to a short or long training and competition break. At the same time, it may not be easy for you to determine what type of muscle injury you have sustained, how long the healing process will take, when and how to rehabilitate, and how to gradually start training again.
How Severe Is the Muscle Injury?
If you practice sports, you have probably experienced or witnessed someone suffering from a “pulled” or “torn” muscle. These are actually the same issue but of different severities. The extent of muscle damage can be classified into several degrees.
Overloaded Muscle – Zero Degree
This is a localized or generalized muscle pain that can occur after exercise. It commonly occurs after intense or unusual exercise involving eccentric load. It usually peaks 24 to 72 hours after the exercise, but the pain eventually goes away on its own after five to seven days. The muscle is painful to move and to the touch, and there may be reduced range of motion and increased levels of creatine kinase in the blood, which is considered an indicator of damage to individual muscle fibers.
Microtrauma – 1st Degree
In this case, there are small injuries to the muscle. The pain is localized and more often appears the following day. There is no loss of strength, and full active and passive range of motion is preserved, though swelling may be present. The injury may involve the muscle itself or the fascia (the connective tissue running through the muscle). It often occurs where the muscle transitions into the tendon. First-degree injuries are relatively quick to rehabilitate, depending on the affected muscle group and the athlete’s load. Full performance is usually restored within 1-3 weeks.
Natržení – 2. stupeň
Při poraněních 2. stupně jde o středně těžká natržení svalu. Sportovec obvykle trpí bolestí již během aktivity. Po 24 hodinách může být přítomno ještě určité omezení rozsahu, bolest při zapojení svalu do pohybu a lehce snížená svalová síla. Stupeň 2 může být lokalizovaný v samotném svalu, ve šlaše, případně v místě přechodu svalu ve šlachu. Pokud jde o poranění povrchové, může být s odstupem patrný hematom (modřina). Při poranění hlubších vrstev svalu hematom nemusí být okem viditelný, protože je v hloubce svalu (prokázat ho lze například při vyšetření ultrazvukem).
Tear – 2nd Degree
In second-degree injuries, there are moderate muscle tears. The athlete typically experiences pain during activity. After 24 hours, there may still be some restriction in range of motion, pain when engaging the muscle in movement, and slightly reduced muscle strength. A second-degree injury can be localized to the muscle, the tendon, or the muscle-tendon junction. If the injury is superficial, a hematoma (bruise) may be visible after some time. In deeper muscle layers, the hematoma may not be visible to the naked eye, but it can be detected with an ultrasound examination.
Extensive Muscle Tear – 3rd Degree
In third-degree injuries, there are extensive muscle tears, leading to a rupture of a significant number of muscle fibers. The injury typically manifests as a sudden onset of pain, making it impossible for the athlete to continue activity. Strength and range of motion remain limited even after 24 hours. Pain occurs with any attempt to engage the muscle in movement. Muscle weakness, significant swelling, and possible hematoma are present.
Muscle or Tendon Rupture – 4th Degree
Fourth-degree injuries involve a complete rupture of the muscle or tendon. This means the tendon has either detached from the muscle belly or the muscle belly is torn into two parts. The athlete experiences sudden pain and is unable to continue any movement of the limb. This type of injury is characterized by severe swelling, pain, and a total loss of function. It most commonly occurs at the tendon-muscle junction. For this type of injury, we recommend seeking immediate professional medical help for diagnosis and prompt treatment.
In more severe third-degree injuries and fourth-degree injuries, surgical intervention is typically required.
How to Help in the First 72 Hours After a Muscle Injury?
In the initial hours following a muscle injury, it is important to prevent swelling in the muscle. The “principle of four” should be followed. For more serious injuries, we recommend consulting a doctor.
- Compression – To relieve the area and prevent swelling, it’s good to bandage the limb with a compression bandage.
- Elevation – If possible, elevate the limb and use anti-gravity positions.
- Icing – Cool the injured area – apply an ice pack or frozen vegetables on the skin through several layers of cotton fabric for 15 minutes. When reapplying ice, the pause should be twice as long as the icing time. It is ideal to start icing immediately after the injury. Icing is most beneficial in the first 48 hours; after that, cold compresses are more suitable.
- Rest – A minimum of 72 hours of rest should be observed if you suspect a muscle injury.
How to Return to Full Training? Why Must I Wait?
The first 10 days are the weakest period for the injured muscle’s scar.
Athletes may often think of trying to “run off the pain.” As a sports enthusiast, I don’t recommend this strategy, and as a physiotherapist, I forbid it :-). Why? Healing, whether it’s a small tear or a significant rupture, follows a similar pattern and requires time. The process involves two phases: first, the destruction phase, where specialized immune cells remove the dead muscle fiber parts, and then the repair and remodeling phase. A scar of connective tissue starts to form between the torn muscle fibers. For the first 10 days after the injury, this scar is the weakest part of the affected muscle. Yes, you’re right: returning to sports prematurely can lead to a chronic problem. Keep in mind that full recovery to pre-injury strength levels can take much longer for some injuries.
Full Performance Typically After Several Weeks
Now we know that going for a jog with a torn hamstring is not the best idea. Ideally, full training will only begin after a series of rehabilitation and compensatory exercises, taking the injury severity into account. For example, recovery times for hamstring tendon injuries are as follows: for severe third-degree injuries, recovery should take 8-16 weeks; for second-degree tears, it should take 4-8 weeks; and for first-degree injuries, the return to sports may take 1-3 weeks.
How Can Physiotherapy Help with Muscle Injury?
Supporting Scar Healing and Accelerating Regeneration
With correctly selected movement, we aim to prevent excessive formation of scar tissue, which could negatively affect the mobility and strength of the healed muscle. This avoids long-term immobilization, which could reduce its strength. The formation of new blood vessels is enhanced, muscle fiber regeneration is supported, their parallel orientation is promoted, and the muscle regains its original strength faster. A physiotherapist can release tight areas using manual techniques. Additionally, the physiotherapist works on improving movement quality to reduce the likelihood of further injury.
Laser and Shockwave Therapy – Improving Muscle Healing
In addition to creating a movement plan, rapid and effective rehabilitation, including physical therapy, is a crucial part of the process. At Fyzio Svět, we use shockwave therapy, which can support tissue healing, stimulate the formation of blood vessels, provide an analgesic effect, and increase metabolic activity in the treated tissue cells. High-performance lasers improve the functional properties of scars, such as elasticity, flexibility, moisture, and blood circulation. They also promote cellular growth, cell regeneration, and an increased synthesis of endorphins that alleviate pain. We also use kinesiology taping techniques to affect not only muscle function but also tendons, ligaments, fascia, and the lymphatic system, helping us quickly deal with swelling and hematomas.
